FAX ORDER FORM

Please print and fill out and fax to 910-424-9563

Please select one below:                                                                                                                                                                                                                  TOTAL $__________________

SHIP GROUND______  SHIP NEXT DAY AIR_____  SHIP 2ND DAY AIR______                                                                                                                TAX IF IN NC $____________

PLEASE CIRCLE CREDIT CARD TYPE AND FILL IN CARD NUMBER BELOW:                                                                                                            S&H CHARGES $___________

VISA      MASTERCARD    DISCOVER    AMEX                                                                                                                                                                       SUB TOTAL $______________

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ EXP DATE _ _  /_ _

SPECIAL COMMENTS:

____________________________________________________

____________________________________________________